Employment and Support Allowance

Employment and Support Allowance (ESA) is paid to people who have difficulty working due to illness or disability. It replaces Incapacity Benefit, Severe Disablement Allowance and Income Support paid on the grounds of disability.

ESA is designed to support people with disabilities and help them find work if they are capable. It is not designed to force people into work if that is not realistically possible. People with severe disability can claim without having to seek employment.

Overview

You can claim Employment and Support Allowance if you are off work for longer than 28 weeks because your brain injury has affected your ability to work. It can be claimed immediately if Statutory Sick Pay (SSP) is not payable or if SSP stops before the 28 week point.

ESA is paid by the government, so decisions are made by the Department of Work and Pensions (DWP). The amount of ESA that you could be entitled to depends on personal circumstances.

There are two different types: contribution-based ESA (c-ESA) and income-related ESA (i-ESA). You can receive either or both, depending on your circumstances.

Contribution-based ESA (c-ESA)

An eligibility criterion of c-ESA is that you need to have paid enough national insurance contributions to be considered for it. It is non-means tested, so your income and savings will not be factored into how much you could be entitled to. However, it can be affected by payments in respect of previous employment. This type of ESA is taxable.

Income-related ESA (i-ESA)

If you have not paid enough national insurance contributions or you have a low household income, you could be eligible for i-ESA. You also need to have savings of no more than £16,000 to be eligible. If you have a partner, their circumstances, income and savings will also be taken into account. This form of ESA is means tested so your income, savings and other capital will be taken into consideration and will determine how much of the benefit you can receive. This type of ESA is not taxable. i-ESA can be replaced in some areas of England, Scotland and Wales by the benefit Universal Credit.

Applying for ESA

You can start the ESA claims process by telephone, textphone or using a simple form:

Your local Jobcentre Plus can help you make a claim if you are having problems.

It is important to try and include as much information as you can about how your brain injury affects your ability to work. This can include physical issues, such as fatigue or headaches, or cognitive issues, such as difficulties with concentration or sustained attention. Once this form has been processed, you might be invited for a face-to-face Work Capability Assessment. You can find more information about filling in the ESA50 form and the Work Capability Assessment in the Headway factsheet The Work Capability Assessment and completing the ESA50 form.

Waiting for an assessment

ESA applications can take a long time to process, sometimes longer than 13 weeks. You might be able to receive a fixed rate (called the assessment rate) of financial support during the waiting period.

If your claim is successful you can also backdate your payments for up to three months before the date of claim if you were unable to work during this time. You will need to provide a medical certificate to prove this. A request for backdated payments should be made at the time of application.

The Work Capability Assessment

If the DWP decides that you might be eligible for ESA based upon the information provided in the ESA application, you will usually have to undertake a Work Capability Assessment. This is a medical test in which your ability to work will be assessed. It usually involves a face-to-face interview and a questionnaire.

The assessment is based on a point scoring system. The number of points that you receive in the assessment determines whether you will be able to receive ESA, and if so, which group you will be placed in from the following:

Work-related activity group

You will be placed in this group if the DWP recognises that you are unable to work at present. However, you will be supported with improving future chances of returning to work. This can be suitable if you are struggling to work for the time being but would like to return eventually, as the effects of brain injury may improve over time. The benefit will be paid for up to one year if you are receiving c-ESA, but can continue to be paid for as long as you qualify if you are receiving i-ESA.

If you have been placed in the work-related activity group, you may have to agree to certain expectations to receive ESA, such as attending work interviews. Failure to meet these expectations may mean that your benefit gets reduced. This is called a sanction.

Support group

You will be placed in this group if the DWP recognises that your brain injury severely limits your ability to work both now and in the future. It will be paid for as long as you qualify, regardless of whether you are receiving c-ESA or i-ESA.

Working on ESA

You are generally not allowed to work while receiving ESA. However, there may be some circumstances in which you can work; this is called ‘permitted work’ and there are strict limits to this. Your ability to complete permitted work while receiving ESA will depend on your circumstances, such as the nature of the work that you are doing. You must inform the DWP if you are considering permitted work.

Challenging an ESA decision

If the DWP decides that you are not eligible for ESA, or you feel that you have been placed into the wrong group, you might wish to apply for a mandatory reconsideration. Details of how to do this will be included in your decision letter. You can have someone help you with this process, such as a family member or an advocate. Mandatory reconsiderations should be made within a month of receiving the decision letter.

If your reconsideration still states that you are not eligible for ESA, you can appeal this decision in an independent tribunal. If you decide to appeal, you have a month from the date of the DWP mandatory reconsideration letter to make an appeal. This is done with an SSCS1 form; you can either access this form online or request a copy from your local Citizen’s Advice Bureau.

The process of appealing against an ESA decision differs in Northern Ireland. For more information, visit the NI Direct government services website. c-ESA continues to be paid for another 365 days if you go into hospital. i-ESA might get reduced after 28 days in hospital, and then may stop if you are in for longer than 52 weeks.

Key points

You can apply for ESA if you are unable to work after 28 weeks, or if you don't qualify for Statutory Sick Pay

There are two types of ESA: contribution-based ESA and income-related ESA. You can receive either or both, depending on your circumstances

You will need to undertake a Work Capability Assessment as part of your application process

If you are able to receive ESA you will be placed in one of two groups: the work-related activity group or the support group

You may be able to complete some work while receiving ESA: this is called 'permitted work'

Headway - the brain injury association is registered with the Charity Commission for England and Wales (Charity no. 1025852) and the Office of the Scottish Regulator (Charity no. SC 039992). Headway is a company limited by guarantee, registered in England no. 2346893.